Stent graft repair of anastomotic pseudoaneurysm of femoral-popliteal bypass graft following patch angioplasty.

Pseudoaneurysm (PA) following vascular reconstruction is a complication of bypass surgery. Historically, the mainstay of treatment was an open repair; the surgical management consisted of resection of the initial graft with reimplantation of a new bypass either into the original arteriotomy or to a more distal target. Placement of a stent graft to exclude the PA is a viable option. We present a case of an 85-year-old man with prior history of polytetrafluoroethylene femoral-popliteal bypass now with an 8 × 5.6 cm PA of the distal anastomosis site treated with endovascular placement of a Viabahn stent.

Venous Adventitial Cystic Disease: A Review of 45 Cases Treated Since 1963.

Purpose. To review and identify the most accurate ways of diagnosing and treating adventitial cystic disease (ACD) of the venous system. Methods. Cases of ACD were collected through three popular medical databases, including PubMed, Cochrane, OVID, and MEDLINE. After reviewing the literature, the sites of occurrence of 323 cases of adventitial cystic disease were documented, and all cases of arterial ACD were excluded. The clinical features, treatment, and subsequent course of 45 cases of venous ACD are included in this paper. Results. After reviewing all 45 cases of venous ACD , we have confirmed that the most common vessel affected is the common femoral vein, which reproduces the most common symptom of venous ACD: asymmetric lower extremity swelling worsening over time. Conclusion. Venous ACD most commonly affects the common femoral vein. When unilateral leg swelling occurs with or without a noticeable mass, ACD should be considered. It is best confirmed with CT venography and the treatment of choice is transluminal cyst evacuation and excision.

Aortobiiliac bypass to the distal external iliac artery versus aortobifemoral bypass: a matched cohort study.

Vascular bypass has long been the standard surgical treatment for symptomatic aortoiliac occlusive disease (AIOD). Conventional wisdom has been that aortobifemoral bypass (ABF) be performed for AIOD because of the inevitable progression of iliac atherosclerosis leading to bypass thrombosis. However, ABF is prone to significant groin incision complications such as infection and lymphocele. The purpose of this study was to determine if aortobiiliac bypass (ABI) to the distal external iliac artery performs similarly to ABF in cases in which minimal atherosclerosis is present in the distal iliac arteries. Of patients undergoing aortic reconstruction for symptomatic AIOD between July 1998 and December 2008, 37 were found to have minimal atherosclerosis in the distal external iliac arteries and underwent ABI. These were compared with patients undergoing ABF using a retrospective matched cohort design. The indication for ABI was claudication in 86.5 per cent and critical limb ischemia in 13.5 per cent. There was no difference found in overall bypass patency. The 1-, 3-, and, 5-year patencies were 97, 92, and 79 per cent in the ABI group and 93, 85, and 76 per cent in the ABF group, respectively (P = 0.8). The incidence of groin wound complications in the ABF group was 14.6 per cent. ABI to the distal external iliac artery achieves equivalent graft patencies to ABF without added risk of associated groin wound complications. These data suggest that ABI be preferentially considered to ABF in situations when the very distal external iliac arteries are patent and free of significant atherosclerotic disease.